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FA <br /> I- Generator's US EPA ID No Manifest Document No. 2. Poy� (Iti{irmation in the shaded areas <br /> UNIF{}RM HAZARDOUS .1 !',not required by Federal law <br /> WASTE MANIFEST I I t of;i .r•' <br /> 3 Generator's Name and Mailing Address <br /> t.'1.1. 1 /''. f 1 04 T A i r 4: '1 <br /> 0 11.-1r.; Lt. I II%isr'r1:1 11„ , , . )t_II I ;l.tt •. ��_._ {. <br /> h d Generator's Phone I ' 1'_1) '1; <br /> (V 5. Transporier I Company Nome 6 US EPA ID Number •i <br /> h <br /> tb <br /> L)�i 'i{_11 I ! fitly rl.lr' <br /> 7. Transporter 2 Company Nome 8 US EPA ID Number <br /> J <br /> 7) 9. Designated Facility Nome end Site Address 10. US EPA ID Number •. <br /> TY',1 I:IIJ IN L*I4\ t I--01Q1 M[:I•,l Al <br /> 12. 6]I V Mn 1 1�1 �.T . ` <br /> it <br /> I 1 US DOT D.•acriplion(including P.c.per Shipping Nome,Hozord Class,end ID Number) , - -12, Containers 13. Total.,1, SLI. Unit <br /> o. <br /> .`^!Z No. T pe Quantity 'WI/Vol <br /> rJC11J f.:r1i'/; I IA 7 <br /> 3 _G � /tit.'•':;f-{1-'1:'1._1!1 ::.. r;111_. ! 11 t'1 ”? '`•�, <br /> ,E <br /> ,N b. <br /> '-4 R <br /> C-4 A — <br /> o T t <br /> m O <br /> R <br /> w d _ rl <br /> r- <br /> Z <br /> U.1 <br /> V • !Y 1` M } <br /> LU <br /> h <br /> Z <br /> , O <br /> C i <br /> rn <br /> W <br /> ac <br /> J <br /> Q <br /> Z15. Special Handling Instructions and Additional Informotion <br /> O <br /> z AF'1?FiOF'F'T/;T E> .10113 ;i "1'L_, J T r 1 .�1{'iokP�a-OI L. 1.00 '-':AU, "EMGf�C1CPti;�` rOtJ7�s1`T; r t]f►c't 7.16- <br /> :%___% <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurotely described above by proper ship name and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicoble international and Malionol government regulations. <br /> V <br /> N-' If I am o longe quoNify generator, I certify that I hove o program in place to reduce tfse volume and toxicity of waste generated ro the degree 1 hove determined to be economicall <br /> practicable and fhot I hove selected the practicable method of treatment,storage,or disposal y <br /> � g posol currently available to me which minimizes the present and future threat to human health <br /> and Ike environment;OR, if I am a small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford- ON BEHALF OF DELTA CONTAINER <br /> )` P n�/ ped Nome <br /> UI/� Signature - a Month Day Year <br /> Z 7/V r�i1 l'� I LA.�ti j 7 7 <br /> siJ T 17. Transporter I Acknowled ement of Recei t of Materials <br /> (7 <br /> W A Printed/Typed Name Signator Month Day Year <br /> so <br /> Lli <br /> III <br /> III JI-111 <br /> LL1 18 Transporter 2 Acknowled ement of Receipt of Materials ,._•,,�;1. <br /> O 1 Printed/Typed Name <br /> W 1 Signature Month Year <br /> *f .Y Day <br />:.� 19, Discrepancy Indication Space ! �, <br /> F <br /> Z .� <br /> 1 <br /> iA i <br /> ( 0 F cili Owner 4 O erator Certification of i of hazardous materials covered 61,this rispinilest except as fed in hem 19. <br /> T P d/ ed Na Mrs! � \ � � Signature � � f.4onlh Do <br /> y if ,C/ ' <br /> 7. <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8027A 11/97) <br /> .EPA 8700-22 Green: TRANSPORTER RETAINS <br />